[The life threatening adverse effects of psychotropic drugs: a case report]

Neuroleptic malignant syndrome (NMS) is a rare idiosyncratic reaction to antipsychotic drugs that is potentially fatal. Characteristic features of NMS are hyperthermia, muscular rigidity, severe autonomic dysregulation and disturbed consciousness. Signs and symptoms of serotonin syndrome (SS) can be grouped into four inclusive categories that are almost identical to those of NMS. Clinically, NMS and SS share many features, suggesting different spectrums of a similar disorder. To make a distinction between the two is often difficult because of a large clinical overlap. We present a case of a 42-year-old male with a history of schizophrenia that developed signs and symptoms inconsistent with either NMS or SS after intramuscular administration of 2 typical antipsychotics along with 1 dose of a selective serotonin reuptake inhibitor (SSRI). The patient abruptly developed the clinical features in just 24 h. The patient presented with altered mental status and increased levels of creatinine phosphokinase. Twelve days of intensive care unit treatment was chiefly supportive and included bromocriptine. The final outcome was positive with complete disappearance of the symptoms. The treatment for both NMS and SS is similar. The therapeutic interventions primarily consist of removing the suspected agent and providing supportive care. We present this case to highlight some controversial issues concerning the life threatening adverse effects of psychotropic drugs, which illustrate the spectrum concept.